Remarks on diarrheal diseases
Diarrheal diseases are the second leading cause of death worldwide in children outside the neonatal period.
Remarks on acute viral gastroenteritis
Most common cause of vomiting and diarrhea in children
and continues to account for over 500,000 deaths globally each year in children <5 years old.
Areas without vaccination program: rotavirus m/c
Areas with widespread rotavirus vaccination: norovirus m/c
Remarks on feeding in gastroenteritis
Continued feeding not only slows the progression of dehydration by increasing the volume of fluid available to the intravascular space, but the presence of nutrients in the bowel lumen also promotes mucosal recovery and improves fluid absorption.
Clinical features of acute viral gastroenteritis
Diarrhea associated with acute viral gastroenteritis typically lasts <7 days and not longer than 14 days, and it may be accompanied by vomiting or fever.
Remarks on isolated vomiting
Isolated vomiting should not be diagnosed as acute gastroenteritis.
Appendicitis and diarrhea
Although appendicitis typically manifests with abdominal pain followed by vomiting associated with constipation, it may also cause diarrhea, particularly once the appendix has perforated. This is presumed to occur because the inflammation irritates the colon, resulting in diarrhea.
A validated dehydration score derived from several clinical studies
Clinical dehydration score, which correlates with length of stay and need for IV rehydration
Obtain CBC only if
if the child is ill-appearing or has bloody diarrhea (mainly to identify bacterial enterocolitis or HUS)
Recommendations for measuring glucose and serum electrolytes
1) Moderately dehydrated children whose history and physical examination findings are inconsistent with acute gastroenteritis.
2) All severely dehydrated children.
3) All children requiring IV rehydration
Fecal leukoctes
More than 5 WBCs per HPF has a sensitivity of 73% and specificity of 84%, and is moderately useful for identifying bacterial gastroenteritis.
High-risk factors that warrant stool cultrures
> 10 stools in the previous 24 hours
Travel to high-risk country
Fever
Older age child
Blood or mucus in stool
Abdominal pain/tenderness
Remarks on imaging
In general, radiologic investigations play a very limited role in assessment of pediatric acute gastroenteritis.
Imaging is valuable when the diagnosis is uncertain, such as may occur in children with isolated vomiting.ª
ªpossible obstructive process
Plain films of the abdomen may be a useful starting point when?
Although plain films of the abdomen are usually nonspecific and have low sensitivity, they may be a useful starting point when looking for
- bowel obstructions
- foreign bodies
- bowel perforation
How can one suspect STEC O157 clinically?
Bloody diarrhea
Minimal or no fever
Severe abdominal pain
Ground beef, undercooked
Differentials for isolated vomiting
Metabolic (DKA)
Increased ICP
Surgical abdomen (appendicitis)
Malrotation - 1 m/o
Obstruction (intussusception) - 1 y/o
